Surveys of outpatient medical facilities have indicated that headache is one of the most common medical complaints of adults (National Ambulatory Medical Care Survey,1981). Epidemiological studies have reported that the incidence rate of migraine in adults is about 20% (Waters & O’Connor, 1975). The incidence rate for muscle-contraction or tension headache has been found to be approximately 80% (Ostfeld, 1963). However, because infrequent muscle-contraction headache can usually be treated using over-the-counter medications, physicians and other health-care providers usually treat only the more severe cases of chronic (almost daily) tension headache.

Behavior, at long last, may be taking its proper place in Western medicine. The study of behavior in medicine has even spawned a new discipline, sometimes called behavioral medicine. In the broadest sense, behavioral medicine refers to the application of behavioral science knowledge and techniques to the understanding of physical health and illness and to prevention, diagnosis, treatment, and rehabilitation. In this chapter, we discuss behavioral medicine only in terms of the application of behavioral therapy and applied analysis to these same areas. An astonishing number of studies have been published in this area, mostly in the past 10 years, and the numbers are increasing exponentially.

The problem of pain in children has received little attention in the medical and psychological literature. In contrast to the wealth of information concerning theory research, and clinical application in the area of pain management with adult patients, the literature on assessment and management of children’s pain is characterized almost exclusively by anecdotal reports and by the absence of systematic, controlled research. The paucity of relevant literature on pediatric pain was illustrated by Eland and Anderson (1977) who conducted a thorough search of the medical literature on pain from 1970 and 1975. The search revealed 1350 articles on pain, yet only 33 of these dealt with pediatric pain. Furthermore, the 33 articles were almost all related to differential diagnosis or specific diagnostic examinations to be done and contained little or no data on assessment or treatment of children’s pain behaviors. Since 1975, psychologists have begun to address the problem of pain in children through research as well as clinical application. The purpose of this chapter is to provide a concise overview of the psychological literature on assessment and intervention in pediatrics.

Research evidence concerning the application of biofeedback techniques to various psychiatric disorders and its use in mental health settings is reviewed. It was concluded that biofeedback treatments are often associated with positive responses along self-reported or observed variables, but that it has been difficult to provide evidence of a specific treatment component. Similarly, studies comparing biofeedback against conventional relaxation techniques typically reveal no differences in treatment outcome between the two. The need to establish a rationale for the inclusion of biofeedback that descends logically from a focus on a targeted response is highlighted. It is suggested that any contributions of biofeed-back to treatment in mental health settings might utilize the unique characteristics of biofeedback technology itself, in addition to offering a supplement to the teaching of relaxation skills.

Relatively large numbers of studies have been done on the association of HLA antigens with multiple sclerosis (MS). As the data in Table 8.1 show, A3 and B7 were significantly increased in most of the studies on Caucasians from Europe and North America. A notable exception is the report by Poskanzer et al.1 on patients from the Orkney Islands (a high-prevalence area) in which no association with the A, B, D, and DR loci antigens was found (Table 8.1). This association was not present in Italy, Iran, and India (all in a medium-to-low risk zone). In Indian patients an association with B12 has been reported.2–4 In a sample of 71 Caucasians from South Africa and 40 from Zimbabwe (a low-risk-zone), no HLA association was observed (Table 8.1).

Behavioral medicine is a new and still evolving concept in the health care field. As noted elsewhere (Gentry, 1982), the term itself has been used in several distinct ways to highlight teaching, research, and clinical service activities of various groups of behavioral, social, and biomedical scientists and clinicians. The two primary tracks of activities that fall under this rubric essentially have to do with: (a) the application of “behaviorism” to medicine, and (b) an integration of thought and technology between biomedical and behavioral science disciplines. The former represents an outgrowth of Birk’s (1973) initial use of the term in defining the merits of biofeedback in treating medical disorders such as asthma, epilepsy, tension and migraine headaches, and Raynaud’s Disease. The latter reflects a consensus definition emanating from the now historic Yale Conference on Behavioral Medicine (Schwartz & Weiss, 1978b) and subsequently amended at a similar meeting held at the Institute of Medicine, National Academy of Sciences (Schwartz & Weiss, 1978a).

Contemporary concern for providing equality of opportunity for both women and men is not only appropriate, it is long overdue. Stereotyped and biased conceptions of the cognitive capacities of women restrict the access of females to many areas of personal, career, and professional development. Sex stereotyping also limits the range of opportunity for males in some areas, although these restrictions are not often emphasized. In the final analysis, both women and men profit from a wide range of opportunity.

In spite of the fact that the field of biofeedback is now well into its second decade, few studies have documented the long-term effectiveness for reducing clinical symptomatology in psychosomatic illness. Integration of those that have been conducted is complicated by the varying treatment modalities, lengths of training, and lengths of follow-up periods employed by the investigators. Moreover, the definition of “success” is necessarily an arbitrary and subjective one, susceptible to the influence of both the patient’s and the evaluator’s expectations. Recognizing these potential sources of error exist, one can nevertheless make some statements regarding long-term effectiveness.

This paper is concerned with what abnormal handedness in Pervasive Developmental Disorders (PDD) reveals about the presence, lateralization, and severity of cerebral dysfunction in this population. From previous work, it was predicted that left-handedness would be elevated in the sample and that mixed-handedness subjects should be more impaired than those with established hand dominance. A battery of cognitive and motor tests were administered to a group of PDD children with autistic symptoms, and performance was compared for the left-handed, right-handed, and mixedpreference children. It was found that left-handers tended to do better than right-handers on all cognitive measures, while the mixed-preference children tended to be the lowest on all cognitive measures. No differences were found on motor measures. An extension of the Satz (1972) model, assuming early brain damage, was developed to explain the superiority of the left-handed children; an alternative explanation assuming anomalous lateralization patterns in the natural left-handers was also suggested.

The logotype of the Mayo institution depicts three shields representing clinical service, research, and education. An approach to current trends and issues in medicine related to educational underachievement (referred to in the United States as “specific learning disabilities”) can be organized into these same three categories of service, research, and education. These concerns are appropriate not only in medicine but also in the fields related to the diverse behaviors underlying unexpected school failure. Physicians have made and will continue to make important contributions to the recognition of academic underachievement and particularly to clarification of the relationship of underachievement to biologic determinants. The views that follow are in part influenced by my experiences and those of my colleagues at the Mayo Clinic involved in the Learning Disabilities Assessment Program.